A. A. Altunkan

Efficacy of tramadol versus meperidine for pain relief and safe recovery after adenotonsillectomy.

Background and objective: Adequate relief of pain after tonsillectomy is a common problem. We compared meperidine and tramadol when given at induction of anaesthesia with respect to their effects on postoperative pain relief and emergence characteristics after adenotonsillectomy in children. Methods: Fifty children aged 4-7 yr undergoing tonsillectomy were randomly assigned to receive either tramadol 1 mg kg−1 (n = 25) or meperidine 1 mg kg−1 (n = 25) before commencement of the surgical procedure. Anaesthesia was induced with propofol (with cis-atracurium for muscle relaxation) and maintained with sevoflurane in oxygen and nitrous oxide. Postoperative pain was scored by a blinded observer using a facial pain scale in the recovery room at 0 (at arrival of the patient in the postoperative care unit) and at 10, 20 and 45 min thereafter. Agitation scores were also assessed by the same observer at 0 min. Heart rate and mean arterial pressure were recorded at regular intervals. The time to recovery to spontaneous respiration and the incidence of postoperative nausea and vomiting were noted. Results: Facial pain scale scores were increased in the tramadol group at 0, 10 and 20 min (P < 0.05). No difference was observed in scores at the 45th min postoperation. Agitation scores were higher in the tramadol group than in the meperidine group. No statistical difference was found between the two groups. Heart rates and mean arterial pressures were similar in both groups. The time to recovery to spontaneous respiration was delayed with meperidine compared with tramadol (P < 0.05). The incidence of nausea and vomiting was not statistically different between groups. Conclusions: Meperidine was more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children.

An Alternative Treatment in Warm Cerebral Ischemia-Reperfusion Injury: Inhibition of Glutamate Neurotransmission

Glutamate neurotoxicity has been implicated in the pathophysiology of cerebral ischemia-reperfusion injury. Therefore, we investigated the effect of glutamate receptor antagonist riluzole in a rabbit model of warm cerebral ischemia-reperfusion. A total of 16 New Zealand rabbits were randomly assigned to one of three groups: Riluzole group (n = 6), which received riluzole (8 mg/kg), control group (n = 5), which received only vehicle before ischemic period, and sham group (n = 5), which had the same operation but did not undergo clamping. To induce warm cerebral ischemia the left carotid artery was occluded for 15 minutes and then reperfusion was allowed. The rabbits were killed after 4 hours of reperfusion. The brain slices were harvested for immunohistochemical examination of platelet endothelial cell adhesion molecule (PECAM) expression and blood samples were taken for measurement of serum superoxide dismutase (SOD), catalase, myeloperoxidase (MPO) and malondialdehyde (MDA) levels. The results indicated that riluzole treatment reduced the relative levels of malondialdehyde and myeloperoxidase and increased SOD levels (P < 0.001). No statistically important difference was determined between riluzole and sham group with respect to these results. We did not find any significant difference in catalase levels among three groups. Immunohistochemical examination showed significant decrease of PECAM expression in riluzole treated animals (P < 0.05). Our findings suggested that riluzole may protect brain in a setting of severe ischemia-reperfusion injury and therefore, be considered for clinical usage.

Comparison of the effectiveness of scoring systems for the poisoning cases admitted to emergency department: A-832

11/2005) all patients being 90 yrs. were analysed. Results and Discussions: Altogether 477 patients (m/f 106/371, mean 95.2; 90–104 yrs.) could be included. 91.3% of all emergency calls were between 6am and 10pm. 6.7% (32pts.) were transported by helicopter. Time from alarming the emergency team to entering the scene was 3–9 min. (mean 3), from scene to hospital 13–73 min (mean 37). 62 Patients died on scene (NACA 7), in 20 patients no further treatment was necessary and transportation to hospital was not performed (2). Out of 13 pts. who had to be intubated on scene only 2 survived.